Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

Castillo, Jimena del; López‐Herce, Jesús; Matamoros, Martha; Cañadas, Sonia; Rodriguez-Calvo, Ana; Cecchetti, Corrado; Rodrı́guez-Núñez, Antonio; Álvarez, A. Carrillo

doi:10.1016/j.resuscitation.2015.07.037

Cited by 41 publications

(23 citation statements)

References 40 publications

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“…Results need to be considered from a developmental perspective. IH-CA is more common in very young children 7,11 and two-thirds of our sample was < 3 years at 12-month follow up. Younger children with IH-CA may be likely to have complex congenital and multisystem disorders.…”

Section: Discussionmentioning

confidence: 71%

Neurobehavioural outcomes in children after In-Hospital cardiac arrest

et al. 2018

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Section: Discussionmentioning

confidence: 71%

Neurobehavioural outcomes in children after In-Hospital cardiac arrest

et al. 2018

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“…Although many IHCAs in children have a noncardiac origin, 11 , 12 , 13 , 14 , 15 10% to 15% have a first documented rhythm that requires defibrillation. 12 , 15 , 16 Early defibrillation in pediatric cardiac arrest has been recommended since 1977, 17 and recent guidelines from both the European Resuscitation Council and the American Heart Association recommend defibrillation as soon as possible after the shockable rhythm is recognized.…”

Section: Introductionmentioning

confidence: 99%

Association Between Time to Defibrillation and Survival in Pediatric In-Hospital Cardiac Arrest With a First Documented Shockable Rhythm

et al. 2018

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Key Points Question In children who have an in-hospital cardiac arrest with a first documented shockable rhythm, is time to first defibrillation attempt associated with survival to hospital discharge? Findings In a cohort study from the Get With The Guidelines–Resuscitation national registry of 477 pediatric patients who experienced in-hospital cardiac arrest, time to first defibrillation attempt was not associated with survival. Time to first defibrillation was also not associated with return of circulation, 24-hour survival, or favorable neurologic outcome. Meaning In contrast to published adult in-hospital cardiac arrest and pediatric out-of-hospital cardiac arrest data, there was no significant association between time to first defibrillation attempt in pediatric in-hospital cardiac arrests with first documented shockable rhythm and survival to hospital discharge.

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“…Although recent guidelines have deemphasized the focus on tracheal intubation during cardiac arrest, especially in the adult population, the optimal approach to airway management during cardiac arrest in general and particularly pediatric in-hospital cardiac arrest remains unknown. 7,28 Underlying pulmonary or airway disease and a presumed respiratory etiology are common in pediatric in-hospital cardiac arrest, 2,3,29 providing the rationale for invasive airway management. However, tracheal intubation during CPR also carries potential complications and risk of adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Categorical variables are presented as counts and frequencies and continuous variables as medians with 25th and 75th percentiles. The χ 2 test was used to compare categorical data between independent groups and the Wilcoxon rank sum test to compare continuous variables. The Cochran-Armitage test was used to test for linear trends in tracheal intubation over time.…”

Section: Methodsmentioning

confidence: 99%

“…1 Most pediatric in-hospital cardiac arrests are precipitated by acute respiratory failure (hypoxia), and relatively few are attributable to primary arrhythmias (eg, ventricular fibrillation or ventricular tachycardia). 2,3 Therefore, the standard paradigm for pediatric in-hospital cardiopulmonary resuscitation (CPR) focuses on early effective respiratory support to establish adequate oxygenation and ventilation and on high-quality chest compressions to provide adequate myocardial and cerebral blood flow. 4 Although there is increasing evidence supporting the importance of high-quality chest compressions for survival from pediatric in-hospital cardiac arrests, 5 less is known about the importance of invasive airway management during CPR.…”

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confidence: 99%

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Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival

Andersen

Raymond

Berg

et al. 2016

JAMA

143

101

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IMPORTANCETracheal intubation is common during pediatric in-hospital cardiac arrest, although the relationship between intubation during cardiac arrest and outcomes is unknown.OBJECTIVE To determine if intubation during pediatric in-hospital cardiac arrest is associated with improved outcomes. DESIGN, SETTING, AND PARTICIPANTSObservational study of data from United States hospitals in the Get With The Guidelines-Resuscitation registry. Pediatric patients (<18 years) with index in-hospital cardiac arrest between January 2000 and December 2014 were included. Patients who were receiving assisted ventilation, had an invasive airway in place, or both at the time chest compressions were initiated were excluded. EXPOSURES Tracheal intubation during cardiac arrest. MAIN OUTCOMES AND MEASURESThe primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and neurologic outcome. A favorable neurologic outcome was defined as a score of 1 to 2 on the pediatric cerebral performance category score. Patients being intubated at any given minute were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. RESULTSThe study included 2294 patients; 1308 (57%) were male, and all age groups were represented (median age, 7 months [25th-75th percentiles, 21 days, 4 years]). Of the 2294 included patients, 1555 (68%) were intubated during the cardiac arrest. In the propensity score-matched cohort (n = 2270), survival was lower in those intubated compared with those not intubated (411/1135 [36%] vs 460/1135 [41%]; risk ratio [RR], 0.89 [95% CI, 0.81-0.99]; P = .03). There was no significant difference in return of spontaneous circulation (770/1135 [68%] vs 771/1135 [68%]; RR, 1.00 [95% CI, 0.95-1.06]; P = .96) or favorable neurologic outcome (185/987 [19%] vs 211/983 [21%]; RR, 0.87 [95% CI, 0.75-1.02]; P = .08) between those intubated and not intubated. The association between intubation and decreased survival was observed in the majority of the sensitivity and subgroup analyses, including when accounting for missing data and in a subgroup of patients with a pulse at the beginning of the event.CONCLUSIONS AND RELEVANCE Among pediatric patients with in-hospital cardiac arrest, tracheal intubation during cardiac arrest compared with no intubation was associated with decreased survival to hospital discharge. Although the study design does not eliminate the potential for confounding, these findings do not support the current emphasis on early tracheal intubation for pediatric in-hospital cardiac arrest.

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Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study

Cited by 41 publications

References 40 publications

Neurobehavioural outcomes in children after In-Hospital cardiac arrest

Neurobehavioural outcomes in children after In-Hospital cardiac arrest

Association Between Time to Defibrillation and Survival in Pediatric In-Hospital Cardiac Arrest With a First Documented Shockable Rhythm

Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival

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